| NPI | 1275838393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY.61459940) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60270904) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60327801) | |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2026-04-14 |