| NPI | 1538728233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60751048) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY9106) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2020-10-21 |