| NPI | 1326338468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA py60546803) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 23472) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2026-04-02 |