| NPI | 1386935807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5345-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional (Licence: WI 5345) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2024-02-08 |