| NPI | 1548005424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 111725) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA t23093) |
| 101YM0800X Counselor, Mental Health (Licence: MN 5283) | |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2025-11-14 |