| NPI | 1669543377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: NC 63) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 5276) |
| 101YP2500X Counselor, Professional (Licence: GA 003049) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |