| NPI | 1083249940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 8065-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 8065-125) |
| 101YM0800X Counselor, Mental Health (Licence: MN 02691) | |
| 101YM0800X Counselor, Mental Health (Licence: IL 180013170) | |
| 101YP2500X Counselor, Professional (Licence: WI 8065-125) | |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2026-02-06 |