| NPI | 1932888740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 4009) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY61665135) |
| 103T00000X Psychologist (Licence: OR 4009) | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2025-12-30 |