| NPI | 1184159113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC8732) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC8732) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC8732) | |
| 101YM0800X Counselor, Mental Health (Licence: MD LC8732) | |
| 101YP1600X Counselor, Pastoral (Licence: MD LC8732) | |
| 106H00000X Marriage & Family Therapist (Licence: MD LC8732) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-02-12 |