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 |