| NPI | 1437382140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60860492) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MT 1465) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2023-11-30 |