| NPI | 1316009632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: WA LW00009568) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC00047472) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2008-11-21 |