| NPI | 1083856405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor Pastoral |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2010-04-16 |