| NPI | 1730576034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA 60756577) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 15-05-12) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2024-03-20 |