NPI | 1770617425 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0064) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 720) |
Enumeration Date | 2007-03-15 |
Last Update Date | 2025-09-11 |