| NPI | 1023397270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 0000000647) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2011-11-20 |