| NPI | 1154926913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 106S00000X Behavior Technician | |
| 174H00000X Health Educator | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2024-09-27 |