| NPI | 1417159476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-07-07 |