| NPI | 1285070102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC007307) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: GA LPC007307) |
| 101YP2500X Counselor, Professional (Licence: GA LPC007307) | |
| Enumeration Date | 2013-05-19 |
| Last Update Date | 2014-03-15 |