| NPI | 1639475031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: LC3005) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: MD LC3005) |
| 101YP2500X Counselor Professional (Licence: MD LC3005) | |
| 101YP2500X Counselor Professional (Licence: DC PRC14059) | |
| 101YP2500X Counselor Professional (Licence: VA 0701004903) | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2013-09-20 |