| NPI | 1497724090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1395) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 1954) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-07-29 |