| NPI | 1215033360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH8720) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: FL MH8720) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |