| NPI | 1962630236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist Rehabilitation (Licence: WA PY60099381) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY60099381) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2009-06-25 |