| NPI | 1205205879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61040080) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61000726) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2021-08-05 |