| NPI | 1932156718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00001409) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA 1409) |
| 103TC0700X Psychologist Clinical (Licence: OR 1104) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2023-10-30 |