| NPI | 1194882738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00002042) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA PY00002042) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |