| NPI | 1811262116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 82070400001) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-01-03 |