| NPI | 1629820071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR T-24-3714) |
| 101YM0800X Counselor Mental Health (Licence: OR QMHA-R-5143) | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-09 |