| NPI | 1497216667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A19198) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-10-23 |