| NPI | 1972074342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF61078528) |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2022-12-13 |