| NPI | 1083833255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39002436A) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 106H00000X Marriage & Family Therapist (Licence: KY 0725) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2015-04-30 |