| NPI | 1114941242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NH 4) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: NH 48) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |