| NPI | 1881416691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ACD.0001376) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO LPC.00112315) |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-10-31 |