| NPI | 1417180910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3438) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T1148) |
| 101Y00000X Counselor (Licence: OR C3438) | |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2022-10-11 |