| NPI | 1336541127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2014-09-23 |