| NPI | 1689639726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 1966) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: SC 4158) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2008-12-04 |