| NPI | 1679685309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR OR CO402) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR OR TO246) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-12-30 |