| NPI | 1124147079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: FL 75029) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 3682) |
| 106H00000X Marriage & Family Therapist (Licence: TX 759) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |