| NPI | 1669647426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60233014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60312220) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60166796) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2015-03-05 |