| NPI | 1508427261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY61519949) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61445611) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-01-08 |