| NPI | 1144235896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM 0413) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 3478) |
| 101YM0800X Counselor, Mental Health (Licence: CO 1865) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2025-04-13 |