| NPI | 1386993962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 1569) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 1249) |
| 101YM0800X Counselor Mental Health (Licence: NE 4502) | |
| 101YP2500X Counselor Professional (Licence: NE 2192) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2020-07-21 |