| NPI | 1083753487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 41) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: 1069) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |