| NPI | 1629143839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 249) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 249) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 249) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2025-09-11 |