| NPI | 1992750798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00002508) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1605) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2024-10-01 |