| NPI | 1043686991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00002233) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: WA PY00002233) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2015-08-14 |