| NPI | 1164929253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1664-132) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 11864-134) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |