| NPI | 1952577124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH 60148410) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00021752) |
| 101YM0800X Counselor Mental Health (Licence: WA RC00021752) | |
| 101YP2500X Counselor Professional (Licence: WA RC00021752) | |
| 106H00000X Marriage & Family Therapist (Licence: WA RC00021752) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2010-06-16 |