| NPI | 1699124883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12336) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-25114) | |
| 101YM0800X Counselor, Mental Health (Licence: NC 12336) | |
| 101YP2500X Counselor, Professional (Licence: NC A12336) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-12-13 |