| NPI | 1689738031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2166) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 385) |
| 101YM0800X Counselor, Mental Health (Licence: NE 604) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-02-07 |