| NPI | 1588359970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-62715) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT BBH-PCLC-LIC-31276) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-15 |