| NPI | 1023836871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374K00000X |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101Y00000X Counselor | |
| 101YP1600X Counselor, Pastoral | |
| 171W00000X Contractor | |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-10-01 |