| NPI | 1043757065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60813144) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 60648083) |
| 101YM0800X Counselor, Mental Health (Licence: WA MC60637828) | |
| 106H00000X Marriage & Family Therapist (Licence: WA MG60648083) | |
| Enumeration Date | 2017-01-28 |
| Last Update Date | 2019-04-05 |