| NPI | 1952839524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WA 61048468) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60788644) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2022-07-21 |