| NPI | 1760054035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00000735) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 0735) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-11-06 |