| NPI | 1720829880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC15145) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC15145) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC15145) | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-01-31 |