| NPI | 1932868262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61431307) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C6795) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0021190) | |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61229219) | |
| 101YM0800X Counselor, Mental Health (Licence: NM CTB-2022-0900) | |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2025-04-09 |