| NPI | 1992348361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA LF61626716) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2026-03-20 |