| NPI | 1164902763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26663) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 17074) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2025-04-14 |