| NPI | 1366642761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401010247) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401010247) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401010247) | |
| 101YP1600X Counselor, Pastoral (Licence: MI 6401010247) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2017-02-02 |