| NPI | 1760917140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3591) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61357253) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-07-31 |