| NPI | 1689969727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T1682) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 96-R-31) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2024-05-13 |