| NPI | 1801228705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 4110-226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 18785-130) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2019-09-24 |