| NPI | 1306255567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2014027182) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 6513) |
| 101YM0800X Counselor Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2021-01-06 |