| NPI | 1235788902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701008565) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701008565) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0701008565) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701008565) | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2021-08-20 |