| NPI | 1801587308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| 374K00000X | |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-08-08 |