| NPI | 1568191310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2026-07-16 |