| NPI | 1922480458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: PA cw018392) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA cw018392) |
| 101YM0800X Counselor, Mental Health (Licence: PA cw018392) | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2015-06-20 |