| NPI | 1609654649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61497160) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL IMT4015) |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2024-03-13 |