| NPI | 1043443831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 000001677) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC60089316) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2024-08-06 |