| NPI | 1356372692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 06-R-02) |
| 101YM0800X Counselor, Mental Health (Licence: OR C1894) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 46459) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-06-09 |