| NPI | 1861855983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701006450) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MA LMHC10000721) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710101930) | |
| 101YP2500X Counselor Professional (Licence: DC PRC200001993) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2025-05-01 |