| NPI | 1194995944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2301) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 106H00000X Marriage & Family Therapist (Licence: OR T0711) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2021-11-02 |