| NPI | 1982275517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC11638) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC11638) |
| 101YP1600X Counselor, Pastoral (Licence: MD LC11638) | |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2021-08-23 |