| NPI | 1528797727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: WA PY61337524) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61337524) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-09-08 |