| NPI | 1942721485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC P016042) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 23146) |
| 101YM0800X Counselor Mental Health (Licence: NC PO12034) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2021-11-11 |