| NPI | 1326396987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: NV none) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR none) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |