| NPI | 1740629609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 26634) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2013-06-24 |