| NPI | 1114228004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2016-10-27 |