| NPI | 1962877266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61113547) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2022-09-28 |