| NPI | 1740419035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX N/A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX N/A) |
| 101YP1600X Counselor Pastoral (Licence: TX N/A) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2009-07-07 |