| NPI | 1871036228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 11506-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17162-130) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2024-02-26 |