| NPI | 1487245627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-43978) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-SWLC-LIC-44257) |
| Enumeration Date | 2021-01-31 |
| Last Update Date | 2021-01-31 |