| NPI | 1942472295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MO 2018044784) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KS 598) |
| 101YP2500X Counselor Professional (Licence: KS 2363) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2019-01-23 |