| NPI | 1487017828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 003308-1) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 4669) |
| 101Y00000X Counselor (Licence: 210101) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 00071051) | |
| 101YM0800X Counselor, Mental Health (Licence: ME CC3015) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2020-05-19 |