| NPI | 1811487721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 097.0136439) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional (Licence: OH C.2305670) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2026-01-21 |