| NPI | 1013218767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60447862) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60197538) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2023-03-07 |