| NPI | 1346768520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12314-MH-CC) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 12314-MH-CC) | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2023-01-23 |