| NPI | 1689162612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13903) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 15767) |
| 101YM0800X Counselor, Mental Health (Licence: FL 15767) | |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2023-05-22 |