| NPI | 1518696111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 106H00000X Marriage & Family Therapist | |
| 103TC1900X Psychologist Counseling (Licence: MI 6362009537) | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-01-09 |