| NPI | 1205356698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60729333) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60729333) |
| 103TC1900X Psychologist, Counseling (Licence: WA PY60729333) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-12-02 |