| NPI | 1124531785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-ACLC-LIC-14219) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 101Y00000X Counselor | |
| 102L00000X Psychoanalyst | |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2017-11-06 |