| NPI | 1770936379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 14378) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 2524-5521) |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |