| NPI | 1255762886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 5797-125) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 16013-132) |
| 101YP2500X Counselor Professional (Licence: WI 1996 - 226) | |
| Enumeration Date | 2013-12-08 |
| Last Update Date | 2021-06-09 |