| NPI | 1194286393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 14600) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 25136) |
| 101YM0800X Counselor Mental Health (Licence: FL TPMC2566) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2022-11-22 |