| NPI | 1023439106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY1806) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001806) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2024-02-26 |