| NPI | 1033435698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60732915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 00010809) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2018-04-16 |