| NPI | 1699205963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60779123) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60779551) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-03-07 |