| NPI | 1023303070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO LPC.0020508) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACC-7097) |
| 101YM0800X Counselor Mental Health (Licence: NM CTB-2023-0229) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2024-04-08 |