| NPI | 1568098713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2389) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61514431) |
| 101YP2500X Counselor, Professional (Licence: AK 215581) | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2024-05-07 |