| NPI | 1811169345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00003705) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: WA LH00003705) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |