| NPI | 1164623005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY 60414394) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: VA 0810006462) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2025-03-25 |