| NPI | 1982920666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61224123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 61903) |
| 101YM0800X Counselor, Mental Health (Licence: CA 61903) | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2023-08-31 |