| NPI | 1912181462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60172528) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00056918) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2018-10-12 |