| NPI | 1427485036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: GA 10114352) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA C0115) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2013-09-27 |