| NPI | 1881228492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD 20691) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 8208) | |
| 101YM0800X Counselor, Mental Health (Licence: SD LPCMH30727Supervisee) | |
| 101YP2500X Counselor, Professional (Licence: SD LPC20691) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-03-31 |