| NPI | 1689749558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0026) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR T0026) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2022-07-18 |