NPI | 1619019296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0039) |
Additional Taxonomies | 101Y00000X Counselor (Licence: OR LPC 0074) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2025-09-11 |