| NPI | 1811987159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00001836) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA PY00001836) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2024-07-19 |