| NPI | 1023774114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19378-130) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: WI R1032909) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2021-11-12 |