| NPI | 1609654649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MFT.LF.70034916) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL MT5313) |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2025-12-22 |