| NPI | 1396951950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00005619) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF00000890) |
| 106H00000X Marriage & Family Therapist (Licence: OR T0224) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |