| NPI | 1851087852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701012369) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 655) |
| 101YM0800X Counselor, Mental Health (Licence: CO 13113) | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |