| NPI | 1184933988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA 603040421) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA 603040421) |
| 101YM0800X Counselor, Mental Health (Licence: WA 603040421) | |
| 101YP2500X Counselor, Professional (Licence: WA 603040421) | |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2010-09-28 |