| NPI | 1588917793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC6217) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: MD LC6217) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2015-03-12 |