| NPI | 1740765544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 61016862) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40071) |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2025-05-29 |