| NPI | 1902415433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN 5317) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 5317) |
| 101YM0800X Counselor, Mental Health (Licence: TN 5317) | |
| 101YP2500X Counselor, Professional (Licence: TN 5317) | |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2025-04-18 |