| NPI | 1801387329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7511-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 7511-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16389-132) | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2026-04-09 |