| NPI | 1457781536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 10489) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3579) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2025-02-13 |