| NPI | 1114628690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: TX 1349187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA C-MHC-301) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-03-13 |