| NPI | 1073496782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 14497) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE P-2329) |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2025-07-29 |