| NPI | 1548668189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3267) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60580546) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2020-08-19 |