| NPI | 1861618662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3741) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY 00003811) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2015-10-22 |