| NPI | 1386232197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC12205) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LGA2796) |
| 101YM0800X Counselor, Mental Health (Licence: MD LGP10160) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2022-03-20 |