| NPI | 1548403694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61493931) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 6883941-3902) |
| Enumeration Date | 2009-04-18 |
| Last Update Date | 2026-03-20 |