| NPI | 1710205232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2721) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60132400) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2024-06-30 |