| NPI | 1881239440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 15357) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26133) |
| 101YM0800X Counselor, Mental Health (Licence: NC A15357) | |
| 101YP2500X Counselor, Professional (Licence: NC A15357) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2023-01-16 |