| NPI | 1184321333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CI5219) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 06892-L) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2025-03-28 |