| NPI | 1215098850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA LF00001070) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LF00001070) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2014-11-19 |