| NPI | 1295277119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60903643) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC- 19475) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2019-03-28 |