| NPI | 1952941148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 12068) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 1744) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2020-01-15 |