| NPI | 1952689614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60215163) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: WA PY60215163) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |