| NPI | 1003572819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61068382) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY61068382) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TS0200X Psychologist, School (Licence: WA PY61068382) | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2021-11-16 |