| NPI | 1538698147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH1211688) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF61513857) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2024-08-12 |