| NPI | 1548077423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT 70172) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 48561) |
| 175T00000X Peer Specialist (Licence: MT 33409) | |
| Enumeration Date | 2024-12-14 |
| Last Update Date | 2024-12-14 |