| NPI | 1194030072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 60465925) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2025-11-04 |