| NPI | 1013558428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 15125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A15125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26602) | |
| 101YM0800X Counselor, Mental Health (Licence: NC A15125) | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2022-11-29 |