| NPI | 1447754239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151.0128054) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2018-04-19 |