| NPI | 1851493431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA 1230) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 1230) |
| 103TF0000X Psychologist, Family (Licence: WA 1230) | |
| 103TH0100X Psychologist, Health Service (Licence: WA 1230) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: WA 1230) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2025-09-11 |