| NPI | 1780184911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA MG60828426) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2021-09-28 |