| NPI | 1750597316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: GA 000591) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 000163) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2011-04-04 |