| NPI | 1215197405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 11425200-6004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional (Licence: CA 900) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2020-03-04 |