| NPI | 1386913192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor Pastoral | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2013-07-05 |