| NPI | 1861246357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-30364) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A21095) |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2025-10-06 |