| NPI | 1730782756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 225A00000X Music Therapist | |
| 374K00000X Religious Nonmedical Practitioner | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2020-11-20 |