| NPI | 1699229534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-22586) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC LCMHC-12557) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2020-08-21 |