| NPI | 1245874312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21712) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 2773) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2025-08-20 |