| NPI | 1760450589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60178159) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF60160552) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2019-10-18 |