| NPI | 1710299250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP1600X Counselor, Pastoral (Licence: OK MCB532) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2022-07-21 |