| NPI | 1801804851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00001029) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 1648) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |