| NPI | 1831278910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA 60934231) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 26796) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-06-30 |