| NPI | 1164723052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C0326) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0332) |
| 106H00000X Marriage & Family Therapist (Licence: CA 13066) | |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2010-11-08 |