| NPI | 1629199245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WV 1830) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WV 1830) |
| 101YP1600X Counselor Pastoral (Licence: WV 1830) | |
| 101YP2500X Counselor Professional (Licence: WV 1830) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |