| NPI | 1669119053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-05-17 |