| NPI | 1144285446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00005416) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF00001047) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-07-08 |