| NPI | 1437502408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13007) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-22365) |
| 101YM0800X Counselor, Mental Health (Licence: NC A13007) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2022-10-26 |