| NPI | 1689228694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY61367593) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61373211) |
| 101YM0800X Counselor Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2023-06-07 |