| NPI | 1538404116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: WA PY60324969) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60324969) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2015-02-19 |