| NPI | 1871006536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3659-57) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60807146) |
| 103T00000X Psychologist (Licence: WA PY60807140) | |
| 103T00000X Psychologist (Licence: OR 2914) | |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2023-12-21 |