| NPI | 1669553921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00000379) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00000379) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-02-12 |