| NPI | 1821163411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0804) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 508309) |
| 101YP2500X Counselor, Professional (Licence: OR C2538) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2024-07-16 |