| NPI | 1912689423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-29212) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A20789) |
| 101YP2500X Counselor, Professional (Licence: NC A20789) | |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2024-11-18 |