| NPI | 1598464356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MT 56139) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 106H00000X Marriage & Family Therapist (Licence: MT 62306) | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-03-01 |