| NPI | 1053616805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0015304) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0001867) | |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2025-02-28 |