| NPI | 1801449988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701008489) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701008489) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0701008489) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-12-21 |