| NPI | 1992146278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA 007582) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2014-05-28 |