| NPI | 1235674334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1796) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1385) |
| 101YM0800X Counselor, Mental Health (Licence: NE 4849) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 1243) | |
| 101YP2500X Counselor, Professional (Licence: NE 2319) | |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2019-01-16 |