| NPI | 1215607494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MFTA.MG.61551477) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61220659) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2024-07-15 |