| NPI | 1417398447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN L000000033783) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN LDC0000000201) |
| 101YM0800X Counselor, Mental Health (Licence: TN L000000033783) | |
| Enumeration Date | 2013-07-06 |
| Last Update Date | 2023-12-06 |