| NPI | 1477754729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY3945) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 00003945) |
| 103TC0700X Psychologist, Clinical (Licence: WA 3945) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-09-02 |