| NPI | 1649355629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L000567) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T0197) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-01-11 |