| NPI | 1477742260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60123458) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00004993) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60071612) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2019-03-19 |