| NPI | 1750627337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 11826) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 11826) |
| 101YP1600X Counselor, Pastoral | |
| 101YM0800X Counselor, Mental Health (Licence: CO 11826) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-12-30 |
| Last Update Date | 2024-07-09 |