| NPI | 1568488724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0623) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C2157) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2011-04-14 |