| NPI | 1023378627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0106606) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 4608) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1834AL) | |
| 101YM0800X Counselor, Mental Health (Licence: IA 114192) | |
| 101YM0800X Counselor, Mental Health (Licence: NY 011191) | |
| 101YM0800X Counselor, Mental Health (Licence: ME CC7016) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2025-12-10 |