| NPI | 1902088032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 3102) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: TX 65976) |
| 101YP1600X Counselor, Pastoral (Licence: OK 3102) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2012-01-13 |