| NPI | 1518964824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: WA PY 60285535) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: WA PY60285535) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2022-03-03 |