| NPI | 1811306137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: WA 60360376) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA 60360376) |
| 103TC0700X Psychologist Clinical (Licence: WA 60360376) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: WA 60360376) | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |