| NPI | 1487059259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003635) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: GA PSY003635) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2014-10-23 |