| NPI | 1780905786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00001702) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 2483) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 2056) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2019-05-24 |