| NPI | 1295372001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ND 693-7-15-277) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1662) |
| Enumeration Date | 2019-12-01 |
| Last Update Date | 2023-06-15 |