| NPI | 1174927446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY61049664) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60736664) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2023-06-29 |