| NPI | 1851156541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |