| NPI | 1578587432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WA PY00000801) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA 600 559 777) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-03-06 |