| NPI | 1295254092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG60982950) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CL60530579) |
| 101Y00000X Counselor (Licence: WA MG60982950) | |
| 101YM0800X Counselor, Mental Health (Licence: WA MG60982950) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2020-08-05 |