| NPI | 1790826808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: CA GGBTS) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2022-02-25 |