| NPI | 1588952741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5955) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 7102) |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-15680) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2025-01-01 |