| NPI | 1770954893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 10341) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA LPC006446) |
| 101YP2500X Counselor, Professional (Licence: GA LPC006446) | |
| 101YP2500X Counselor, Professional (Licence: WI 22417) | |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2023-12-27 |