| NPI | 1932457678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 27841) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY 60317249) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2016-09-24 |