| NPI | 1659718625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY CARC-90) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: OK 200924) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2013-10-16 |