| NPI | 1629052592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60556155) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: HI 1013) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-11-02 |