| NPI | 1922257336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 01124-L) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: NV NO NUMBER) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2008-09-10 |