| NPI | 1437300886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60280005) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR C71703791840906) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2019-06-03 |