| NPI | 1811634207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LGP15722) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD ADT2649) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2025-06-10 |