| NPI | 1912095548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0000X Psychologist, Family |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP1600X Counselor, Pastoral | |
| 103T00000X Psychologist | |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-09-11 |