| NPI | 1356055594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2024-06-02 |