| NPI | 1952744161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15923-131) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7386-125) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2025-05-30 |