| NPI | 1376169318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2459) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR T2459) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-10-09 |