| NPI | 1215237607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 2996-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 12639-131) |
| 101YP2500X Counselor, Professional (Licence: WI 2996125) | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2022-09-01 |