| NPI | 1578163200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61117678) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005320) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2025-10-22 |