| NPI | 1740743319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY61131091) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61131091) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2022-01-18 |