| NPI | 1568870780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR G 130804) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2023-08-28 |