| NPI | 1033687090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8241-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 4208-226) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 18715-130) | |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2022-04-19 |