| NPI | 1417300468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60769223) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60679555) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2018-03-17 |