| NPI | 1831987270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA DB903146) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA DB903146) |
| 101YP1600X Counselor, Pastoral (Licence: LA DB903146) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: DB903146) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: LA DB903146) | |
| Enumeration Date | 2025-04-26 |
| Last Update Date | 2025-04-29 |