| NPI | 1447702857 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101Y00000X Counselor (Licence: IN 39002124A) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002124A) | 
| 101YP1600X Counselor, Pastoral (Licence: IN 39002124A) | |
| Enumeration Date | 2016-11-02 | 
| Last Update Date | 2016-11-02 |