| NPI | 1356009872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PSYC.PY.70051340) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PSYC.PY.70051340) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2026-08-13 |