| NPI | 1396523437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 11882-125) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 20000-130) |
| 101YM0800X Counselor Mental Health (Licence: WI 7352-226) | |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2025-06-26 |