| NPI | 1508936931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 1454) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WA 1454) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 1454) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-11-17 |