| NPI | 1134262884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00001701) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA PY00001701) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2009-01-13 |