| NPI | 1851864029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 7748) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 18517) |
| 101YP2500X Counselor, Professional (Licence: WI 3942-226) | |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2023-08-25 |