| NPI | 1780813345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA RC60103553) |
| 103TC0700X Psychologist, Clinical (Licence: WA HP60107685) | |
| 103TC1900X Psychologist, Counseling (Licence: CT HYP0000284) | |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2009-09-01 |