| NPI | 1538702725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0017582) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0017190) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0001622) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2023-04-29 |