| NPI | 1831238070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00003572) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WA MHC.LH.0003572) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2026-06-30 |