| NPI | 1043933260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61597963) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MG61269730) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2025-04-09 |