| NPI | 1205521945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0704014735) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: VA 0704014735) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-13 |