| NPI | 1326179177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: WA 3718) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 1608) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |