| NPI | 1144907239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 11397-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL LPC05677) |
| 101YP2500X Counselor, Professional (Licence: OR c10698) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20096-130) | |
| 101YP2500X Counselor, Professional (Licence: FL TPMC5894) | |
| 101YP2500X Counselor, Professional (Licence: MN 3114) | |
| 101YP2500X Counselor, Professional (Licence: TX 98418) | |
| 101YP2500X Counselor, Professional (Licence: IL 178.021877) | |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2026-02-11 |