| NPI | 1982123006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401225382) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-03596) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-24075) | |
| 101YM0800X Counselor, Mental Health (Licence: MI 6451022467) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2025-08-04 |