| NPI | 1790079101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2614) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC44519) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2015-07-30 |