| NPI | 1114467834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT1294) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: 3181) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |