| NPI | 1467182006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61317966) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA MC61317966) |
| 101YS0200X Counselor, School (Licence: WA MC61317966) | |
| 103K00000X Behavior Analyst (Licence: WA MC61317966) | |
| 106H00000X Marriage & Family Therapist (Licence: WA MC61317966) | |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-05-21 |