| NPI | 1891739413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA 1538) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1007) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2008-08-06 |