| NPI | 1851975056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 4078-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61278527) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2024-09-26 |