| NPI | 1497631832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-SWLC-LIC-49499) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-ACL-LIC-50588) |
| Enumeration Date | 2025-08-12 |
| Last Update Date | 2025-08-12 |