| NPI | 1760941116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16291) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 16291) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2019-03-15 |