| NPI | 1568904670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60608652) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: WA PY60608652) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY60608652) | |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2018-08-22 |