| NPI | 1851858237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0718000340) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2019-02-21 |