| NPI | 1700107794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 003398) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2012-09-25 |