| NPI | 1699179242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9428) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID CADC-5045) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60898613) | |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2024-01-08 |