| NPI | 1366781932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WA PY00002443) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY00002443) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY00002443) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00002443) | |
| Enumeration Date | 2013-02-02 |
| Last Update Date | 2022-07-21 |