| NPI | 1811486442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 376787-3902) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: UT 376787-6006) |
| 101YM0800X Counselor Mental Health (Licence: UT 376787-3904) | |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2019-10-20 |