| NPI | 1912450040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 101YP2500X Counselor, Professional | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |