| NPI | 1841702826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 103TC1900X Psychologist, Counseling | |
| 103TF0000X Psychologist, Family | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2017-10-30 |