| NPI | 1245695899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 12076-125) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: WI 217-36) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01483) | |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2025-09-30 |