| NPI | 1417977059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-04730) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: NM 9585) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-12 |