| NPI | 1255367181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00002935) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY2935) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-08-16 |