| NPI | 1053665125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2024-12-12 |