| NPI | 1750656161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2350) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60246979) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2022-07-21 |