| NPI | 1720331119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5498-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16671-130) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16193-132) | |
| 101YP2500X Counselor, Professional (Licence: WI 1546-226) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2023-10-30 |