| NPI | 1396664629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PSYC.PY.60344023) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.60298316) |
| Enumeration Date | 2026-07-11 |
| Last Update Date | 2026-07-11 |