| NPI | 1508139601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: OR 1744) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: WA 2937) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2012-02-20 |