| NPI | 1770888190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60263160) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LF60263160) |
| 101YM0800X Counselor, Mental Health (Licence: WA LF60263160) | |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2013-03-26 |