| NPI | 1073128559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 8975) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 8975) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 182820120) | |
| 101YP1600X Counselor Pastoral (Licence: CA 8975) | |
| 374K00000X Religious Nonmedical Practitioner (Licence: CA 8975) | |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-09-14 |