| NPI | 1831669043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MS 2335) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MS 2335) |
| 101YM0800X Counselor Mental Health (Licence: MS 2335) | |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2020-12-01 |