| NPI | 1598072019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60098310) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CPO60143886) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2015-08-07 |