| NPI | 1437792793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001745) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 001745) |
| 101YP1600X Counselor, Pastoral (Licence: IA 001745) | |
| 101YP2500X Counselor, Professional (Licence: IA 001745) | |
| Enumeration Date | 2019-10-19 |
| Last Update Date | 2019-10-19 |