| NPI | 1407322381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61189478) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA MC60701724) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2022-04-04 |