| NPI | 1659889640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor Pastoral (Licence: NC 116) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 22716) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2020-02-05 |