| NPI | 1609137744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1362) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60052791) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2024-04-30 |