| NPI | 1740303163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 25920) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY00003532) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2019-05-09 |