| NPI | 1700853744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2006000741) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2006000741) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 2006000741) | |
| 101YP1600X Counselor Pastoral (Licence: MO 2006000741) | |
| 101YS0200X Counselor School (Licence: MO 2006000741) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-11-12 |