| NPI | 1265162630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103K00000X Behavior Analyst | |
| 106H00000X Marriage & Family Therapist | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2022-06-16 |