| NPI | 1689174757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R10553) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: UT 13147561-6009) | |
| 101YM0800X Counselor, Mental Health (Licence: CA 13095) | |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2025-01-07 |