| NPI | 1821237744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60969939) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC60063415) |
| 103G00000X Clinical Neuropsychologist (Licence: WA PY60969939) | |
| 103K00000X Behavior Analyst | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY60969939) | |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2020-11-04 |