| NPI | 1215964176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00002445) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH00004415) |
| 103TC0700X Psychologist Clinical (Licence: OR 1437) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-04-11 |