| NPI | 1912909730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC0912) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA414) |
| 101YM0800X Counselor, Mental Health (Licence: MD LC0912) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-02-09 |