| NPI | 1083903926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 715062-6004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 5715062) |
| 101YM0800X Counselor, Mental Health (Licence: UT 5715062-6004) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2023-01-10 |