| NPI | 1679816136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: WA PY60167546) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY60167546) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2013-04-03 |