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 |