| NPI | 1245885169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 3479) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60955164) |
| 103T00000X Psychologist (Licence: WA PY61013442) | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2023-04-25 |