| NPI | 1013438555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 6632) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000610) |
| 101YM0800X Counselor, Mental Health (Licence: TX 78816) | |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00934800) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701010791) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2024-06-17 |