| NPI | 1396206421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60997726) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60997726) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2021-08-14 |