| NPI | 1508046640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00002974) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY2974) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY2974) | |
| 103TF0000X Psychologist, Family (Licence: WA PY2974) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WA PY2974) | |
| 103TF0200X Psychologist, Forensic (Licence: WA PY2974) | |
| 103T00000X Psychologist (Licence: WA PY00002974) | |
| 103T00000X Psychologist (Licence: PY00002974) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2024-08-16 |