| NPI | 1013481266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 12244) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-22493) |
| 101YP2500X Counselor Professional (Licence: NC 12244) | |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2024-04-16 |