| NPI | 1992331367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61171792) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2022-03-18 |