| NPI | 1184401317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61496084) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA SA61483882) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2025-09-11 |