| NPI | 1558670059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA TE61190395) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY28490) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2021-08-23 |