| NPI | 1649817560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LC10076) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 8159) |
| 101Y00000X Counselor (Licence: MD LC10076) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD LC10076) | |
| 101YP1600X Counselor Pastoral (Licence: MD LC10076) | |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2021-08-19 |