| NPI | 1598062622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH60969209) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF80066) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2020-01-27 |