| NPI | 1861813164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16045-132) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 12024-120) |
| Enumeration Date | 2014-01-04 |
| Last Update Date | 2016-08-15 |