| NPI | 1477699718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY004378) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW004579) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-12-23 |