| NPI | 1558673459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0005795) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61336704) |
| 101Y00000X Counselor (Licence: IL 180007370) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD0000409) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2026-04-23 |