| NPI | 1366203127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR CADC-05-20-2083) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2024-01-18 |