| NPI | 1366054579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8712-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19254-130) |
| 101YP2500X Counselor, Professional (Licence: WI 4759-226) | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2022-08-30 |