| NPI | 1982001590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010129) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC7984) |
| 101YP1600X Counselor, Pastoral (Licence: MD LGP5220) | |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2023-05-02 |