| NPI | 1962034827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2020-02-09 |