| NPI | 1568275279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-27100) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP.0004268) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ICADC.0126588) | |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-01-28 |