| NPI | 1962395418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP1600X Counselor Pastoral | |
| 172A00000X Driver | |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-06-02 |