| NPI | 1184611477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00004858) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF00000852) |
| Enumeration Date | 2005-10-01 |
| Last Update Date | 2007-07-08 |