| NPI | 1871745794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY60275617) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00059125) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2026-09-04 |