| NPI | 1871890269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: GA 09103511) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: GA 575) |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2022-07-21 |