| NPI | 1679596100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: 109) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 3545) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |