| NPI | 1912756206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-72952) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-44056) |
| 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-64610) | |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2024-11-01 |