| NPI | 1639254469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: WA PY00001795) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00001795) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2008-10-10 |