| NPI | 1861822165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60468316) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA MG60468517) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2014-12-22 |