| NPI | 1982131736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2018-12-21 |