| NPI | 1730510009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC6340) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC6340) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC6340) | |
| 101YM0800X Counselor, Mental Health (Licence: MD LC6340) | |
| 101YP1600X Counselor, Pastoral (Licence: MD LC6340) | |
| 106H00000X Marriage & Family Therapist (Licence: MD LC6340) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2020-05-11 |