| NPI | 1740443860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY 00003860) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WA PY00003860) |
| 1041C0700X Social Worker, Clinical (Licence: OR L6002) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2023-11-28 |