| NPI | 1134194764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF00002041) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004199) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00003952) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2017-01-20 |