| NPI | 1780723312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00003976) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF00001434) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |