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 |