| NPI | 1215067590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 004235) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 101YP2500X Counselor, Professional (Licence: OH C 0500011) | |
| 101Y00000X Counselor (Licence: 231125) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-06-04 |