| NPI | 1023889649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 101YP2500X Counselor Professional | |
| 103K00000X Behavior Analyst | |
| 174H00000X Health Educator | |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-01-11 |