| NPI | 1679685689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR OB2818) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY00003470) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-04-12 |