| NPI | 1518271303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY60254025) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071007308) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2013-07-05 |