| NPI | 1780978023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA PY60230406) | |
| 103TC0700X Psychologist, Clinical (Licence: WA PY60230406) | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY60230406) | |
| 103TF0000X Psychologist, Family | |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2021-04-09 |