| NPI | 1659817575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC009304) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: GA 02131595) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |