| NPI | 1023306677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60389198) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 92225) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2022-12-08 |