| NPI | 1427551324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 011362) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV CP5785-R) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV CP5785-R) | |
| 101YM0800X Counselor, Mental Health (Licence: NV CP5785-R) | |
| 101YP2500X Counselor, Professional (Licence: NV CP5785-R) | |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2025-01-10 |