| NPI | 1841702446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| Enumeration Date | 2017-11-04 |
| Last Update Date | 2017-11-04 |