| NPI | 1740472240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AK 229) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH00006863) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2007-08-17 |