| NPI | 1295446110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 171400000X Health & Wellness Coach | |
| 106H00000X Marriage & Family Therapist | |
| 225XM0800X Occupational Therapist, Mental Health | |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2022-12-12 |