| NPI | 1730638255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NC 2016-3282-01) |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2017-06-08 |