| NPI | 1487774923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PR 1163) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 76444G) |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP1600X Counselor, Pastoral | |
| 101YS0200X Counselor, School | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: PR 76444G) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: PR 76444G) | |
| 163WS0200X Registered Nurse, School (Licence: PR 76444G) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2015-07-30 |