| NPI | 1992014120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PSYC.PY.70101154) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 2552) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2026-08-25 |