| NPI | 1144741836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13087) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24732) |
| 101YM0800X Counselor, Mental Health (Licence: NC A13087) | |
| 101YM0800X Counselor, Mental Health (Licence: OR C9639) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2025-03-18 |