| NPI | 1003400813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2021-03-03 |