| NPI | 1013525872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21434) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 266) |
| 101YM0800X Counselor, Mental Health (Licence: NC 11829) | |
| 101YM0800X Counselor, Mental Health (Licence: SC 7282) | |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2022-10-13 |