| NPI | 1821011891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60462687) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 1771) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-05-28 |