| NPI | 1942835285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 13251407-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH21841) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100777) | |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2023-10-09 |