| NPI | 1942401500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60190567) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY0521) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2018-03-26 |