| NPI | 1053559708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY 00001768) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY 00001768) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA PY 00001768) | |
| 103TC1900X Psychologist Counseling (Licence: WA PY 00001768) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA PY 00001768) | |
| 103TF0000X Psychologist Family (Licence: WA PY 00001768) | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2016-08-16 |