| NPI | 1104964675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: GA LPC005480) | |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2020-11-20 |