| NPI | 1689989311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF00001818) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00005902) |
| 101YP2500X Counselor, Professional (Licence: TX 15655) | |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2010-08-18 |