| NPI | 1922272301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0624) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR C2145) |
| 101YP2500X Counselor Professional (Licence: OR C2145) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2009-01-26 |