| NPI | 1447642376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61341481) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60939862) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2024-04-26 |