| NPI | 1255634127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PR AC-III-15-62-0034) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: PR TC-III-15-62-0041) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |