| NPI | 1689228694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61367593) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health | |
| 101Y00000X Counselor (Licence: WA MC61373211) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2024-12-16 |