| NPI | 1861741043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000235A) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: IN 2081776) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2021-04-02 |