| NPI | 1750887394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 8911135) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 8911135) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-10-14 |