| NPI | 1528629789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: S.0020298) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LICDC.131023) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-05-18 |