| NPI | 1609955657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 0806P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY 3413) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-12-07 |