| NPI | 1144687997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA LH60759610) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60759610) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2018-01-15 |