| NPI | 1922889880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61498806) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH24128) |
| 101YP1600X Counselor, Pastoral (Licence: FL Ordained) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP0100303) | |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2024-07-31 |