| NPI | 1902909989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 2879) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 291) |
| 101YM0800X Counselor Mental Health (Licence: NC S2879) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2022-07-08 |