| NPI | 1023148269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00001360) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY00001360) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY00001360) | |
| 103TC0700X Psychologist, Clinical (Licence: WA PY0001360) | |
| 103TC1900X Psychologist, Counseling (Licence: WA PY00001360) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2024-07-05 |