| NPI | 1225813637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 108034-6004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 108034-6008) |
| 225800000X Recreation Therapist (Licence: UT 108034-4002) | |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2023-08-25 |