| NPI | 1841465036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YM0800X Counselor, Mental Health (Licence: OR C2916) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2024-01-19 |