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 |