| NPI | 1962934166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R4446) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR R4446) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-05-01 |