| NPI | 1659381507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 18) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 683) |
| 101YM0800X Counselor, Mental Health (Licence: NE 2105) | |
| 101YP2500X Counselor, Professional (Licence: NE 1200) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-06-09 |