| NPI | 1619266970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA 347612) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 101YS0200X Counselor School (Licence: GA 1379346) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2025-02-12 |