| NPI | 1538543152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 0954) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NH 0954) |
| 101YP2500X Counselor Professional (Licence: NH 0954) | |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2021-07-30 |