| NPI | 1518323369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 10804) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21265) |
| 101YM0800X Counselor, Mental Health (Licence: 10804) | |
| 101YP2500X Counselor, Professional (Licence: OR C4915) | |
| Enumeration Date | 2016-01-10 |
| Last Update Date | 2018-08-27 |