| NPI | 1003569989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY004572) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61652280) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2026-05-26 |