| NPI | 1073799102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MN 2498) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA RC00056737) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2022-09-22 |