| NPI | 1477975605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH23026) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO 11727) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 317) | |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2024-04-23 |