| NPI | 1982088480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R4462) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2018-03-17 |