| NPI | 1366739435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60252354) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH60225628) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2022-05-26 |