| NPI | 1275072407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-02-21 |