| NPI | 1154859064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1681) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR R4759) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2022-07-21 |