| NPI | 1821040700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: WA 60066173) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY 60066173) |
| 103TH0004X Psychologist, Health (Licence: WA PY 60066173) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2018-07-17 |