| NPI | 1093245961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 6374-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-07-31 |