| NPI | 1023240090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C1833) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C1833) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR C1833) | |
| 101YP2500X Counselor, Professional (Licence: OR C1833) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2022-06-18 |