| NPI | 1629568142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 120417) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |