| NPI | 1457782658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 007141) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: NY 007141) |
| 101YP2500X Counselor, Professional (Licence: NY 007141) | |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2021-02-04 |