| NPI | 1336201029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00002727) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY00002727) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2008-03-14 |