| NPI | 1831307602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 1327) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA 1327) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 1327) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA 1327) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-10-20 |