| NPI | 1326468109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY70101574) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60953720) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2026-03-23 |