| NPI | 1063603074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C0410) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0274) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2018-01-10 |