| NPI | 1235836933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1626) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA 1626) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP1600X Counselor, Pastoral (Licence: LA 1626) | |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-02-13 |