| NPI | 1972356293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A19709) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A19709) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-29446) | |
| 101YP2500X Counselor, Professional (Licence: NC A19709) | |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-06-24 |