| NPI | 1780132035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61483423) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 00005912) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2024-02-27 |