NPI | 1871900845 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC17618) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA369) |
101YP1600X Counselor, Pastoral | |
Enumeration Date | 2014-07-22 |
Last Update Date | 2014-07-22 |