| NPI | 1316599053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: FL ST75201) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-12 |