| NPI | 1558332742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA LPC000298) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: GA LMFT000140) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2008-02-13 |