| NPI | 1396493441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61505118) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: WA MC61286801) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2024-10-08 |