| NPI | 1730510413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CMH0219691) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0176001) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2023-11-29 |