| NPI | 1669898599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA LMHC11959) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2024-07-25 |