| NPI | 1275629925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 1999135679) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: VA 6015) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-03-26 |