| NPI | 1932805090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH25101) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA PC015320) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH25101) | |
| 101YP2500X Counselor, Professional (Licence: PA PC015320) | |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2025-02-11 |