| NPI | 1932717923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61106088) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2024-05-29 |