| NPI | 1801950241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3771) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY2238) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY8392) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2013-12-20 |