| NPI | 1699827840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 2952) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY00003717) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2018-09-20 |