| NPI | 1467275990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR R10461) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHP-R-3237) |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-12-03 |