| NPI | 1639230808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00002216) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: WA PY00002216) |
| 103T00000X Psychologist (Licence: WA PY00002216) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |