| NPI | 1477234565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 29298) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A19203) |
| 101YP2500X Counselor, Professional (Licence: NC A19203) | |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-09-08 |