| NPI | 1932295383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY56) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY00000622) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-07-10 |