| NPI | 1679259865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT BBH-LCPC-LIC-64297) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT BBH-ACLC-LIC-55316) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2024-02-06 |