| NPI | 1578270609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA MG61271406) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA MG61271406) |
| 103TF0000X Psychologist, Family (Licence: WA MG61271406) | |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2022-10-28 |