| NPI | 1003030917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00003406) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00003756) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2024-09-10 |