| NPI | 1164072260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist Rehabilitation (Licence: WA PSYC.PY.60961656) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA PSYC.PY.60961656) |
| 103TC0700X Psychologist Clinical (Licence: WA PSYC.PY.60961656) | |
| 103TH0004X Psychologist Health (Licence: WA PSYC.PY.60961656) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2020-03-05 |