| NPI | 1821418633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60449151) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA MG60449387) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2015-07-02 |