| NPI | 1386009553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA 60837656) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA 60837656) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA 60837656) | |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2024-05-06 |