| NPI | 1457940165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 2408) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-27066) |
| 101YM0800X Counselor Mental Health (Licence: NC 12302A) | |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2022-11-19 |