| NPI | 1679782312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA 507709) |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |