| NPI | 1619111051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2023-01-04 |