| NPI | 1255176343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2024-08-21 |