| NPI | 1912553199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 11948) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1544) |
| 1041C0700X Social Worker, Clinical (Licence: NE 7390) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |