| NPI | 1740503556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC16525) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 1590) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302801) | |
| 101YM0800X Counselor, Mental Health (Licence: DC 200012606) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701014977) | |
| 101YM0800X Counselor, Mental Health (Licence: OH E.2606573) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2026-06-29 |