| NPI | 1518330083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60595515) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60595515) |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 12441967-2501) | |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2022-11-14 |