| NPI | 1376850016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 04986) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IA 04986) |
| 101YP1600X Counselor, Pastoral (Licence: IA 04986) | |
| 101YP2500X Counselor, Professional (Licence: IA 04986) | |
| 1041C0700X Social Worker, Clinical (Licence: IA 04986) | |
| 106H00000X Marriage & Family Therapist (Licence: IA 04986) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |