| NPI | 1588092100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2021039488) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC003666) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 79676) | |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC003666) | |
| 101YP2500X Counselor, Professional (Licence: GA LPC003666) | |
| 101YP2500X Counselor, Professional (Licence: TX 79676) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2024-10-23 |