| NPI | 1023362613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0012306) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401013334) |
| 101YP2500X Counselor, Professional (Licence: TX 86425) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD0000621) | |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC1178) | |
| Enumeration Date | 2012-11-03 |
| Last Update Date | 2024-01-05 |