| NPI | 1184762916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: FELLOW6813) |
| 101YP2500X Counselor Professional (Licence: OR C1233) | |
| 106H00000X Marriage & Family Therapist (Licence: OR T0367) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2024-08-01 |