| NPI | 1578937454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C6909) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR R5789) |
| 372600000X Adult Companion | |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2022-12-06 |