| NPI | 1215426176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61375452) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61158547) |
| 101YM0800X Counselor, Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2023-11-02 |