| NPI | 1285682914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA PY0003082) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA PY0003082) |
| 103TC0700X Psychologist Clinical (Licence: WA PY0003082) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-09-11 |