| NPI | 1306246392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61111308) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2569) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2021-07-21 |