| NPI | 1083031488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 4927) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: LA CBC-236) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2014-03-24 |