| NPI | 1962256669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YS0200X Counselor School | |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-08-21 |