| NPI | 1104157593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 4663) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2013-05-13 |