| NPI | 1891826558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60266005) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 22410) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2014-02-03 |