| NPI | 1740314871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6631) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C5919) |
| 106H00000X Marriage & Family Therapist (Licence: OR T2054) | |
| 106H00000X Marriage & Family Therapist (Licence: OR T1760) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2023-09-15 |