| NPI | 1033204565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60099784) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA #LH00009536) |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-08-11 |