| NPI | 1891806675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY16221) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61229677) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-09-09 |