| NPI | 1881779601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00001778) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: WA PY00001778) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2009-03-27 |