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