| NPI | 1568101517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 27947) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2022-10-12 |