| NPI | 1679680334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33116) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001670) |
| 103TC0700X Psychologist, Clinical (Licence: WA 1670) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2024-06-18 |