| NPI | 1518354463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AK 147112) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61266436) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2025-07-08 |