| NPI | 1649693508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG60573141) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MG60573141) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2022-07-21 |