| NPI | 1124750070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MFT.LF.61635492) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 160645) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2026-06-29 |