| NPI | 1235210675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC APPLIED FOR LICENSE) |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |