| NPI | 1073859963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39003597A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health (Licence: FL MH13868) | |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2025-08-08 |