| NPI | 1912563297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61354283) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61361608) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2022-10-13 |