| NPI | 1952607848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH 10512) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2011-02-10 |