| NPI | 1992319685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-25688) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC A15781) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2023-09-01 |