| NPI | 1306608682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-10219) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID LPC-10219) | |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-09-17 |