| NPI | 1255137667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA3520) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101Y00000X Counselor | |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-10-15 |