| NPI | 1831689710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60866264) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60866264) |
| 103TR0400X Psychologist, Rehabilitation (Licence: WA PY60866264) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2025-11-19 |