| NPI | 1497906986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY61018950) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OR 3272) |
| 103TC0700X Psychologist Clinical (Licence: AK 576) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2023-03-22 |