| NPI | 1720430382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23557) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 12058) |
| 101YP2500X Counselor, Professional (Licence: NC A12058) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2020-11-18 |