| 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 |