NPI | 1336347947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.004755) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YM0800X Counselor, Mental Health (Licence: PA PC004482) | |
Enumeration Date | 2007-07-05 |
Last Update Date | 2025-07-31 |