| NPI | 1699887901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA MALMHC 2066) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: MA MALMHC 2066) |
| 101YM0800X Counselor, Mental Health (Licence: RI MHC00455) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-09-01 |