| NPI | 1144949298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP1600X Counselor, Pastoral | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |