| NPI | 1104306414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MD LGP8618) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LGP8618) |
| 101YM0800X Counselor, Mental Health (Licence: MD LGP8618) | |
| 101YP2500X Counselor, Professional (Licence: MD LGP8618) | |
| 101YP2500X Counselor, Professional (Licence: MD LC13983) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2023-07-24 |