| NPI | 1053667725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 9546) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2086) |
| 101YP2500X Counselor, Professional (Licence: NC A9546) | |
| 101YP2500X Counselor, Professional (Licence: NC 291214) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3037) | |
| 101YM0800X Counselor, Mental Health (Licence: NC A9546) | |
| 101Y00000X Counselor (Licence: NC 9546) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2015-11-10 |