| NPI | 1922395565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2969) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61384058) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2023-09-28 |