| NPI | 1649585274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R7867) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 22-08-10494) |
| 372600000X Adult Companion | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2025-01-15 |