| NPI | 1700291929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3975) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60837330) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2025-08-19 |