| NPI | 1679904452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106H00000X Marriage & Family Therapist (Licence: WA LH60541876) | |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2018-08-17 |