| NPI | 1720307689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010939) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC005961) |
| 101YP2500X Counselor, Professional (Licence: MD LC3472) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1003-0705) | |
| 164X00000X Licensed Vocational Nurse (Licence: GA LPN070659) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2023-05-11 |