| NPI | 1124651633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA 60933890) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA 60933918) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-02-13 |