| NPI | 1295990216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081H0002X (Licence: WA MD 60238525) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD 60238525) | |
| 2081H0002X (Licence: CA 146152) | |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2023-02-15 |