| NPI | 1053994939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 146L00000X Emergency Medical Technician, Paramedic | |
| 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2021-04-29 |