| NPI | 1134885338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7635-226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20405-130) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2023-11-15 |