| NPI | 1396124012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60736567) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60486891) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-08-22 |