| NPI | 1093978439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: 1118453) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134348) |
| 101YM0800X Counselor, Mental Health (Licence: PA PCO13988) | |
| 101YP1600X Counselor, Pastoral (Licence: GA 839) | |
| 101YP2500X Counselor, Professional (Licence: GA LPC007918) | |
| 101Y00000X Counselor (Licence: VA 509630) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA GA- CPD0016) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2024-05-03 |