| NPI | 1861709990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-202538) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY 00002290) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2010-09-10 |