| NPI | 1053458786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 16810) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2008-01-16 |