| NPI | 1093352288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 2008) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 1326) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IA 20008) | |
| 101YM0800X Counselor Mental Health (Licence: IA 099193) | |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2022-08-11 |