| NPI | 1578956132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY 60313079) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 013002-1) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2023-11-10 |