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 |