| NPI | 1780153957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 344353-6009) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 3443536018) |
| Enumeration Date | 2018-11-17 |
| Last Update Date | 2023-05-23 |