| NPI | 1912475575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF60947986) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MG60666270) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2023-01-31 |