| NPI | 1720519176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61127703) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106H00000X Marriage & Family Therapist (Licence: WY PMFT-284) | |
| 106H00000X Marriage & Family Therapist (Licence: WY WY-LMFT237) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-03-13 |