| NPI | 1629214473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR p8101007) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0238l) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2025-11-16 |