| NPI | 1790862001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60516246) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY17786) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-06-15 |