| NPI | 1710344775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OK 7016) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor Mental Health | |
| 405300000X Prevention Professional (Licence: OK 7016) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2020-02-21 |