| NPI | 1619353851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: WA PY61536516) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61536516) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY61536516) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2024-09-05 |