| NPI | 1255406955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00001724) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY13338) |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY13338) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-12-30 |