| NPI | 1487877379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 1283) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY 2250) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |