| NPI | 1609085919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 17135) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 214764) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2421L) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH6116) | |
| 101YP2500X Counselor, Professional (Licence: SC 4814) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-11-28 |