| NPI | 1982901435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCSW - 33650) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCSW - 33650) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LCSW - 33650) | |
| 101YP1600X Counselor, Pastoral (Licence: ID LCSW - 33650) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2021-08-10 |