| NPI | 1447638440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16054) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 6314) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2022-12-12 |