| NPI | 1932676608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 15233) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21098) |
| 101YM0800X Counselor, Mental Health (Licence: GA LPC010427) | |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014070) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2022-12-05 |