| NPI | 1144389529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PSY000732) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: WA PSY000732) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |