| NPI | 1902152119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60752644) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 4847) |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT99007) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2018-09-27 |