| NPI | 1760637219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701007739) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC10487) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0718000356) | |
| 101YM0800X Counselor Mental Health (Licence: IN 39003460A) | |
| 101YP2500X Counselor Professional (Licence: DC PRC15236) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2022-03-25 |