| NPI | 1497813612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60115722) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ID PSY203273) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY60115722) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2026-01-07 |