| NPI | 1467608679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0011920) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH17995) | |
| 101YP2500X Counselor, Professional (Licence: MO 2008023816) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2022-11-12 |