| NPI | 1356312177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF00001310) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH00006157) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-09-11 |