| NPI | 1639880784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 000309) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001117) |
| 101YP1600X Counselor, Pastoral (Licence: SC 8617) | |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2023-03-16 |