| NPI | 1144459306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA PY 60073200) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY 60073200) |
| 103TC1900X Psychologist Counseling (Licence: WA PY 60073200) | |
| 103TF0000X Psychologist Family (Licence: WA PY 60073200) | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2014-11-10 |