| NPI | 1194725630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW00004820) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00005137) |
| 106H00000X Marriage & Family Therapist (Licence: WA LF00000902) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2007-07-17 |