| NPI | 1821025453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06382) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60061186) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-11-05 |