| NPI | 1275128399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A16843) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC Pending) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 28124) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2023-02-17 |