| NPI | 1164039764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC LCMHC-8264) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-2453) |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-09-28 |