| NPI | 1912095548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP1600X Counselor Pastoral | |
| 103T00000X Psychologist | |
| 103TE1100X Psychologist Exercise & Sports | |
| 103TF0000X Psychologist Family | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-09 |