| NPI | 1790082865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15923) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60118011) |
| 101YM0800X Counselor, Mental Health (Licence: OR 22244) | |
| 101YM0800X Counselor, Mental Health (Licence: UT 10467990-6004) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 09-12-75U3) | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2021-05-20 |