| NPI | 1346819893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61131690) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61135362) |
| Enumeration Date | 2021-06-20 |
| Last Update Date | 2022-10-06 |