| NPI | 1609292192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 10709) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 10709) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 10709) | |
| 101YP2500X Counselor, Professional (Licence: MA 10709) | |
| Enumeration Date | 2014-03-09 |
| Last Update Date | 2022-09-07 |