| NPI | 1013437748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A12877) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CSAC21416) |
| 101YM0800X Counselor, Mental Health (Licence: NC A12877) | |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2017-06-23 |