| NPI | 1831564053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60623682) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60623682) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2020-12-07 |