| NPI | 1609948678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA WAPSY1297) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: WA PSY 1297) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-01-25 |