| NPI | 1871176180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC S6853) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 21607) |
| 171400000X | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-05-04 |