| NPI | 1629422175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3372) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61009916) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2024-01-22 |