| NPI | 1194239665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13179) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23683) |
| 225C00000X Rehabilitation Counselor (Licence: NC 00188145) | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2021-03-17 |