| NPI | 1932205358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 2700125) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 2700-125) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 12125) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-09-06 |