| NPI | 1073857124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9687) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21403) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9687) | |
| 101YP2500X Counselor, Professional (Licence: NC 21403) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2022-09-06 |