| NPI | 1235553736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 16935) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-27624) | |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2023-05-23 |