| NPI | 1922591254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 6746125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 6746-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16206-132) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-03-23 |