| NPI | 1104869619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: NC 40) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 2405) |
| 106H00000X Marriage & Family Therapist (Licence: NC 601) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2025-05-07 |