| NPI | 1447529276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 14-R-16) |
| 101YP2500X Counselor Professional (Licence: WA LH60389325) | |
| 106H00000X Marriage & Family Therapist (Licence: OR T0928) | |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2016-11-16 |