| NPI | 1033358700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5280-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15254) |
| 101Y00000X Counselor (Licence: WI 5280-125) | |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2026-05-12 |