| NPI | 1770387045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC A21253) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 30621) |
| 101YP2500X Counselor Professional (Licence: SC 10337) | |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-05-15 |