| NPI | 1548433261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0866) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-06-19) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60796757) | |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2023-12-27 |