| NPI | 1679109490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0704012899) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710102528) |
| 101YM0800X Counselor Mental Health (Licence: VA 0701013070) | |
| 101YP2500X Counselor Professional (Licence: VA 0701013070) | |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2024-02-09 |