| NPI | 1710709076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 133047-121) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 20137-130) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |