| NPI | 1134606080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 14048) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC A24464) |
| 101YM0800X Counselor, Mental Health (Licence: A14048) | |
| 101YP2500X Counselor, Professional (Licence: NC A14048) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-07-23 |