| NPI | 1083059596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID 4893) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CAAR.CG.60748346) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2017-04-04 |