| NPI | 1023224607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist Family (Licence: WA PY 1823) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF00001362) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |