| NPI | 1639588742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 6245) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV CI0144) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01680-I) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2024-01-23 |