| NPI | 1598548109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-29052) |
| 101YM0800X Counselor Mental Health (Licence: NC STOC-J827Z3) | |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-08-16 |