| NPI | 1619516812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY61143669) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810006398) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2021-09-24 |