| NPI | 1356687297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701005341) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701005341) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0701005341) | |
| 101YM0800X Counselor Mental Health (Licence: VA 0701005341) | |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2019-07-29 |