| NPI | 1760629133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 3909) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: WA 3909) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 3909) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA 3909) | |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2009-01-07 |