| NPI | 1063978559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA lh61088852) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2019022129) |
| 101YP2500X Counselor, Professional (Licence: MO 2017031420) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2021-02-19 |