| NPI | 1326465337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13924) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001491A) |
| 101YM0800X Counselor, Mental Health (Licence: IN 39002764A) | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2023-05-30 |