| NPI | 1578812376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61501501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY005662) |
| 106H00000X Marriage & Family Therapist (Licence: TX 205134) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF60778001) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2024-09-02 |