| NPI | 1326473935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY 60214473) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA PY 60214473) |
| 103TH0004X Psychologist Health (Licence: WA PY 60214473) | |
| 103TH0100X Psychologist Health Service | |
| 103TP0814X Psychologist Psychoanalysis (Licence: WA PY 60214473) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: WA PY 60214473) | |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2013-09-13 |