| NPI | 1518574961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26586) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15964) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |