| NPI | 1497132450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH13748) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: FL 17022) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-11-04 |