| NPI | 1811100969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC0700X Psychologist, Clinical (Licence: WA 601) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |