| NPI | 1205974128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: WA PY00002013) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP00003361) |
| 103T00000X Psychologist (Licence: WA PY00002013) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2019-03-01 |