| NPI | 1679197370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA TE61174944) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA TE61174944) |
| 103TC0700X Psychologist, Clinical (Licence: OR 3247) | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2021-05-19 |