| NPI | 1609930395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MD LCM422) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: MD LC2001) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2015-10-28 |