| NPI | 1699243931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: WA PY60925498) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103T00000X Psychologist (Licence: WA PY60925498) | |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2021-03-27 |