| NPI | 1518942770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WA PY00002607) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY00002607) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY00002607) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00002607) | |
| 103TH0100X Psychologist, Health Service (Licence: WA PY00002607) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WA PY00002607) | |
| 103T00000X Psychologist (Licence: WA PY00002607) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: WA PY00002607) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2022-07-21 |