| NPI | 1013773183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 10684-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19734) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-02-26 |