| NPI | 1841756327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A14619) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-25057) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2022-04-14 |