| NPI | 1497209225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 7904-125) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2020-07-28 |