| NPI | 1750594156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0864) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C3204) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-03-15 |