| NPI | 1619019296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR LPC 0074) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0039) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |