| NPI | 1245532753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY.60115389) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY60115389) |
| 103T00000X Psychologist (Licence: WA PY60115389) | |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2013-03-26 |