| NPI | 1558322495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 3249) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: NC 0045) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2007-07-24 |