| NPI | 1831755230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC013033) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA LPC013033) |
| 101Y00000X Counselor (Licence: GA LPC013033) | |
| 101YP2500X Counselor, Professional (Licence: GA LPC013033) | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2025-11-05 |