| NPI | 1457647695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60974878) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60535582) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2021-06-14 |