| NPI | 1053518795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY 60063517) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY 60063517) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY 60063517) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2016-08-17 |